Regional Referrals Specialist - Full Time
The Regional Referral Specialist plays an integral part in the care coordination of all Borrego Health patients. The Regional Referral Specialist ensures high quality and timely coordination of care for patients to reduce any delays and barriers to care for all Borrego Patients. In addition, the Regional Referral Specialist is responsible for providing necessary data for ongoing monitoring of Referral Utilization and processing. While maintaining patient satisfaction and safety the Regional Referral Specialists works closely with all necessary departments to promote efficient and solidified processes throughout the organization.
Essential Duties and Responsibilities:
1. Involved in the development, and implementation of necessary training to all Referral Care Coordinators (RCC).
2. Participate in quality improvement (QI) processes for referrals department.
3. Active participant in all Referral related workgroups and assigned committees and annual Referral Roundtable.
4. Performs monthly referral audits for referral management compliance within region and/or assigned to, documents all findings accordingly.
5. Performs quarterly workflow analysis for all RCC’s within region and/or assigned to and documents findings.
6. Provides Clinic Managers with monthly referral reports, RCC Audit results, and workflow analysis.
7. Provides clinic coverage when needed.
8. Ability to travel.
9. Reports and tracks monthly referral statuses.
10. Communicates audit results with Clinic Managers and Referrals Administration.
11. Remains informed of all current and new changes in health plan referrals processes.
12. Develop and implement policies and processes as they pertain to referrals workflow and improvement.
13. Assist Clinic Managers during interview process for recruitment of new staff.
14. Provides recommendations for Provider assignment to manage workload at the individual clinic level.
15. Fosters relationships with Specialty Offices and Specialty Service Centers to enhance access and care to Borrego health patients.
16. Monitors and evaluates entry of all new referrals into the i2i referral module; documentation of all interventions to include, date and time.
17. Ability to perform all Referral Care Coordinator responsibilities.
18. Send letters to patients when unable to reach by phone; handle all returned letters.
19. Handle all incoming calls for the department in a courteous manner; provides callers with an answer to their questions as best as possible.
20. Seeks assistance of supervisor when unable to process all referrals to avoid backlog and the clinical consequences of delays.
21. Provides quality care to the patients of Borrego Health, within the scope of practice outlined by state or federal law.
22. Delivers care in accordance with established standard of care and accepted community standards.
23. Understands the organizations commitment to provide high quality patient care. Promotes a Patient centered environment.
24. Develop understanding of programs such as but not limited to Excel, PPT, Microsoft Word, Moodle, Tableau, Visio etc.
25. Other duties as assigned.
1. Diploma from an approved High School or GED Equivalent.
2. Three years’ experience in the medical field with understanding of insurance and medical terminology
3. Three years minimum experience in processing referrals in a primary care setting.
- Tipo de pago Salario
- Nivel de formación requerido Escuela secundaria
- Escondido, California, EE. UU.
- San Diego, California, EE. UU.